Tag: Family Planning

Categories
Population

Look Out for the Sahel

Field in Niger, Africa

To Deal with Environmental Problems

“Our common goal is the improvement of the quality of life for all, both now and for succeeding generations…. To deal with the social, economic and environmental problems, we must achieve zero population growth within the lifetime of our children.” 

Joint statement signed by 58 of the World’s Scientific Academies                                (1994, before ICPD)

Last month I wrote about the International Conference on Population and Development that took place in Cairo, Egypt, 25 years ago. That experience inspired me to increase my activism on population and to start writing these essays.

            The primary thrust of ICPD was to turn the global focus away from population and to bend it toward reproductive health. This change was in reaction to the dark side of some past population programs: coercive tactics to get people to accept family planning—especially sterilization. Although the goal was to be more humanitarian, it may backfire.

            After reading my November column on ICPD, a doctor whom I respect highly chided me. Dr. Malcolm Potts wrote “Richard, I was also at the ICPD, which I thought at the time – and continue to think – was a step backwards.”

Feedback

             I appreciate the many comments I receive on my population essays. They help to inform and inspire me as well as keep me honest. Although I gave a positive slant to ICPD last month, I have to agree with Dr. Potts—that conference seemed to ignore that the world was already overpopulated 25 years ago.

            Another friend who was also there wrote: “I gave a paper on population issues and the unsustainability of current levels of population growth. …the attendance was light and nobody really cared.” Although the rate of growth has decreased in the intervening quarter century, we have gained over 2 billion more people. The climate crisis is evidence that our planet is even more overpopulated

             No place reflects the failure of ICPD more than sub-Saharan Africa, and especially the Sahel. It is a band across the center of Africa that has barely enough precipitation to support life. The land is overgrazed already and people are degrading the environment even more. Despite this, some of the world’s highest population growth rates are in the Sahel. The average woman in Niger (one of the Sahelian countries) will bear 7 children during her lifetime!

            Combine the area’s aridity and fast population growth with climate change and you have a recipe for a potential disaster. Add military conflicts and hundreds of thousands of refugees and things look even worse. Already many countries in the Sahel depend heavily on foreign aid for food, but that is not sustainable.

            Developments in the Sahel reminds me of what happened in a country a bit to the south. People in Rwanda had killed each other shortly before ICPD. Although ethnic and political causes are usually cited as the reasons of this genocide, another theory makes sense to me. James Gasana’s “Remember Rwanda” in World Watch magazine paints a different picture. As a former Rwandan Minister of Agriculture and Environment, Gasana felt hunger due to overuse of resources fueled that violence.

            I am alarmed by an article published November 2019 in the journal Nature, “Avert catastrophe now in Africa’s Sahel”. Already there are thousands of people escaping Africa to Europe. We may see another genocide if crowding and conditions worsen in the Sahel.

4 suggestions to Prevent Catastrophe:

Invest in girls’ education and reconsider marriage laws. We all know that educating girls and women is one of the best ways to slow population growth—plus education is good in itself. What is less well known is that the norm in many places is for girls to be subjected to an arranged marriage when they are teens or younger.

Expand access to family planning. I spent time in Northern Ghana where large families are common. A program to increase access to family planning did little to slow growth. Why? Apparently the people there are loath to discard traditions and benefit from small family size. Organizations such as the Population Media Center could help change old practices.

Increase agricultural production. No till farming, mulching and techniques of water harvesting can increase production markedly.

Act now. The best chance to slow emigration from the Sahel and prevent disaster needs international aid to act quickly. However, the Sahel would be less likely to explode if ICPD had focused more on population 25 years ago.

© Richard Grossman MD, 2019

Categories
Population

See how Rwanda has Changed

     A friend told me about the International Conference on Family Planning to be held in Rwanda, and asked if I planned to go. I responded: “I am ambivalent about Rwanda; the country has a bad emotional feeling for me, despite what the Rwandans have done to deal with their genocide.”

     Nevertheless, Gail and I found ourselves in Kigali last November. We had a pleasant stay at a modest hotel near the beautiful modern convention center. The city’s lack of litter amazed us! While most cities we have visited have trash in the streets, there was none in Kigali. We learned about one of the reasons for this: the government has mandated that every Rwandan donate their labor to the country on the last Saturday morning of each month. After the community work there is a community meeting with community leaders to discuss problems. This service is called “Umuganda”.            Umuganda dates back hundreds of years but has been resurrected to become a tool for reconciliation. In the local Kinyarwanda language this word means “coming together in common purpose” and is just one way the Rwandan government promotes peace in the country. Another policy was a benefit to us. Whereas French used to be the prevailing European language (the country was a Belgian colony), now English is the primary language of instruction.            The article “Remember Rwanda” was one of the reasons that I had not felt good about visiting Rwanda. It suggests that one of the causes of the genocide there was overpopulation. People in many parts of the country in 1994 had too little ground to grow food and too little to eat. They became violent because they were starving.
            The Rwandans have made an amazing turn-around! People are no longer labeled as either by ethnicity (largely artificial distinctions)—they are all Rwandans. School children visit the Kigali Genocide Memorial to learn about their country’s history and ways to promote peace—so did we.
The healthcare system has improved markedly. Recall how important it is for a country to have a low under-five mortality rate if it is trying to slow its growth. Well, this important measure of child health in Rwanda is just a fifth of what it was just 15 years ago! As Rwanda’s Minister of Health, Dr. Diane Gashumba said “Investing in Universal Health Coverage (UHC) is one of the smartest investments a country can make.” The number of doctors in the country is low, but they are well distributed. Each village has a small clinic which is often attended by a nurse or community health worker. Almost all Rwandans have inexpensive health insurance, making it easy for the people to access primary health care. Unexpectedly, Rwanda has a unique system to deliver family planning.
            Notice that the Minister of Health is a woman! There are many women in the Rwandan government, including half of the cabinet ministers. Their parliament is also dominantly female, with 60% of the seats of the lower house held by women—the highest percentage in the world! People in the government are young, with the youngest cabinet minister just 31 years old.
            Education has taken a turn for the better, too. Whereas most African countries charge tuition for even elementary students, Rwanda abolished school fees for basic education in 2003. Enrollment soared! Recall that education of girls and women is one of the best ways of empowering women and increasing the use of family planning.
About half of Rwandans are Roman Catholic and are supposed to not use “artificial” contraception. The Church runs many of the Rwandan hospitals and clinics, so they cannot distribute contraception. However, the government has found a way around this limitation. Near each Catholic facility is a small family planning clinic that compliments the care of the Catholic facility.
            FamilyPlanning2020, the organization that is delivering family planning care in 69 countries, collaborates with the Rwandan governmental programs. They have provided an additional quarter million men and women with contraception since 2012. The most popular method is the “Depo” shot that is quite effective and lasts 3 months. Unfortunately, few men participate—only 1 in 12 couples uses condoms and vasectomy is rare.
            People in Rwanda are still poor—the average annual per capita income is less than $2000. However the government is making great strides to improve the lives of its people. They are strengthening the 3 most important things to help slow population growth: increase access to family planning, educate and empower girls and women, and promote the heath of children.

© Richard Grossman MD, 2019